VOLUNTARY DENTAL PLAN OPTION - DHMO · • DHMO network is a subset of the current Flex2 network that you use today. • You must go “In-network” to use the DHMO plan • Plan

VOLUNTARY DENTAL PLAN OPTION - DHMO

Plan year: 7/1/2019

862420 d

Offered by Cigna Health and Life Insurance Company or its affiliates

City of Waterbury

A New Voluntary Dental Benefit Plan - DHMO

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna

• Cigna offers a Fully Insured Alternative Dental Plan

• The Plan provides Basic Protection PLUS Coverage

for treatments & care that are otherwise excluded from

the Basic Flex2 Dental Plan in place currently

• This plan is offered as a choice to employees who may

need greater protection and a plan that will pay for

expensive treatments as well as regular, basic care

• Employees can choose between the Flex2 or DHMO

Plan (Can’t enroll in both; and no dental only coverage.)

• Will be offered this open enrollment beginning in May

.

2

* The term “DHMO” is used to refer to product designs that may differ by state of residence of enrollee, including, but not

limited to, prepaid plans, managed care plans, and plans with open access features. The Cigna Dental Care (DHMO) product

availability varies by state and is subject to change.

** There are no out-of-network benefits with a Cigna Dental Care plan except in the case of emergencies. For residents of

MN and OK coverage is available out-of-network. See Appendix A for details.

What is a Dental Health Maintenance Organization?


• A DHMO offers services through a narrower network of dentists

• The plan is able to offer covered members much greater

benefits because of deeper discounts

• There are no deductibles and no calendar year maximums

• Members must choose a primary care dentist in the Cigna Dental

Care network

• Members can change a network dentist at any time; changes

become effective the month after a change is requested

• Members pay the charge for each service listed on the Patient

Charge Schedule

• There is no out-of-network coverage (except in emergencies)**

Cigna Dental

Care® Dental

Health

Maintenance

Organization

(DHMO)*

.

3

* The term “DHMO” is used to refer to product designs that may differ by state of residence of enrollee, including, but not

limited to, prepaid plans, managed care plans, and plans with open access features. The Cigna Dental Care (DHMO) product

availability varies by state and is subject to change.

** There are no out-of-network benefits with a Cigna Dental Care plan except in the case of emergencies. For residents of

MN and OK coverage is available out-of-network. See Appendix A for details.

What is a Dental Health Maintenance Organization? (Cont’d.)


• A “Narrower Network” means the choice of dentists is more

limited than in regular, broad network plans with limited coverage

• Members will need to weigh the value of richer reimbursements

from the plan against possibly changing dentists for a limited time

• If a member decides to enroll in the DHMO, they can switch

back to the Flex2 Plan next open enrollment after the

expensive care is complete

• The DHMO premium is lower than Flex2 premium and members

will pay the same cost share; so less premium comes out of each

paycheck

• Oral Health Integration Program all charges paid in full, no annual

maximums.

Cigna Dental

Care® Dental

Health

Maintenance

Organization

(DHMO)*

.

4

5Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna

• DHMO network is a subset of the current Flex2

network that you use today.

• You must go “In-network” to use the DHMO plan

• Plan name is: Cigna Dental Care Access Plus

• To find a DHMO provider call 1.855.511.6366

or go to www.cigna.com (see brochure)

Cigna Dental

Care® Dental

Health

Maintenance

Organization

(DHMO)*

What is a Dental Health Maintenance Organization? (Cont’d.)

http://www.cigna.com/

Cigna Dental – Voluntary DHMO & Current Flex2 - Overview

DHMO

In-network coverage only

Flex2

In & Out-of-Network

Deductible

Individual

Family (Aggregate)No Deductible

No Deductible

$50 Annual Deductible

$150 Annual Deductible

Annual Maximum No Plan Maximum

(There is no annual limit for any

member annually)

$1,000 per member Maximum (Each

Family Member is limited to $1,000

annually)

Cleaning – Adult (D1110) 100% (2 per calendar year)

Additional cleanings $40 copay

100% (2 per calendar year)

No additional cleanings

Cleaning – Child (D1120) 100% (2 per calendar year)

Additional cleanings $30 copay

100% (2 per calendar year)

No additional cleanings

Basic Services100%

100%

After Deductible

Major Services60%

50%

After Deductible

DHMO

In-network coverage only

Flex2

In & Out-of-Network

Orthodontics Adult & Child - 60%

No lifetime maximum

1 treatment per lifetime

No Coverage

Temporomandibular Joint Syndrome (TMJ)60%

No Coverage

Surgical Implants60%

No Coverage

General Anesthesia/IV sedation 100% No Coverage

External Bleaching $165 patient charge

No Coverage

Occlusal guards 60%

No Coverage

Sealants 100%

No age limits No Coverage

Cigna Dental – Voluntary DHMO & Current Flex2 Overview - (cont’d.)


Dental Rates


Monthly Rates Flex2 DHMO

Single $37.55 $28.68

2-Party $97.61 $74.56

Family $120.11 $91.76

Note: Employer and Employee % cost shares for the DHMO will match cost shares in place for the Flex2 Plan.

CARE PROVIDED

Scenario 1

Orthodontics : (treatment is done within 24 months)

AMOUNT BILLED

Dentist Bills the Plan

CIGNA’S DISCOUNT - DHMO

Net Payable to In-network Dentist &

Patient Share

Flex 2

No Coverage

Orthodontics(includes records, banding, treatment, retention)

$6,000 ($3,754.96 is contracted fee)Cigna will pay 60 % of $3,754.96 =

$2,252.98 Patient will pay 40% of $3,754.96 =

$1,501.98

Patient will pay = $6,000

Examples - Illustrative purposes only

9

Data provided is based on average charges for care rendered in CT for City of Waterbury enrollees. The above is for illustrative purpose only.


Note: If orthodontic treatment is already in progress on 7/1, bills for treatment incurred after 7/1 only are eligible if coverage is elected.

CARE PROVIDED

Scenario 4Crown

AMOUNT BILLED


CIGNA’S DISCOUNT - DHMONet Payable to In-network Dentist

& Patient Share

($584 contracted fees)

Flex 2Net Payable to In-network Dentist

& Patient Share

($796 contracted fees)

Crown $840Cigna will pay 60 % of $584 =

$350.40

Patient will pay 40% of $584 = $233.60

Cigna will pay 50 % of $796 (after deductible of $50) = $373.00

Patient will pay 50% of $796 plus deductible $50 = $423.00




CARE PROVIDED

Scenario 3

Implant

AMOUNT BILLED




Patient Share

Flex 2


Patient Share

Implant $1,300 ($794 contracted fee)

Cigna will pay 60 % of $794 = $476.50 Patient will pay 40% of $794 = $317.60

Not covered Patient will pay = $1,300




Note: If orthodontic treatment is already in progress on 7/1, bills for treatment incurred after 7/1 only are eligible if coverage is elected.

CARE PROVIDED

Scenario 3Bridge

AMOUNT BILLED




Patient Share

Flex 2


Patient Share($1,000 annual benefit maximum)

Bridge: 4 unit bridge for 4 teeth $6,052

($2,136 contracted fee)

Cigna will pay 60 % of $2,136 = $1,281.60

Patient will pay 40% of $2,136 =$854.40

($4,702 contracted fee)

Cigna will pay 50 % of $4,702 after $50 deductible (up to $1,000

lifetime maximum met)= $1,000Patient will pay = $3,702




Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna 13

HELP WITH YOUR ORAL HEALTHPrograms and services

Dental servicesHeart

diseaseStroke Diabetes Maternity

Chronic

kidney

disease

Organ

transplants

Head and

neck cancer

radiation

Periodontal treatment and maintenance

(D4341, D4342, D49101)u u u u u u u

Periodontal evaluation (D0180) u

Oral evaluation (D01202, D01402, D01502) u

Cleaning (D11103) u

Scaling in the presence of inflammation – Full

Mouth (D43463) u

Emergency palliative treatment (D91104) u

Topical application of fluoride and topical

application of fluoride varnish (D12065)u u u

Topical application of fluoride – excluding

varnish (D12085)u u u

Sealants (D13515) u u u

Sealant repair – per tooth (D13535) u u u

Cigna Dental Oral Health Integration Program®

Available to ALL Cigna Dental customers

with qualifying condition(s)

Articles on behavioral issues

linked to oral health

Discounts on prescribed mouthwashes, fluoride

gels, and toothpastes from your dentist*

More programs More wellness More discounts

* Pharmacy discounts are available through Cigna Home Delivery Pharmacy only. This is a discount and is NOT insurance. This discount is

separate from your dental benefits and you are required to pay the entire discounted charge. You should check any insurance or other benefits

you have before using these discounts, as those benefits may result in lower costs to you.

1. Four times per year. 2. One additional evaluation. 3. One additional cleaning. 4. No limitations. 5. Age limits removed, all other limitations apply.

PROGRAMS

& SERVICES


More than just dental benefits

Cigna

Healthy

Rewards®*For DPPO and

Cigna Dental Care

(DHMO)

Cigna Healthy Rewards

Discounts on a full range of

health and wellness programs

and services

Identity Theft

Resolution

Services**

For Cigna Dental

Care (DHMO) only

Help with critical issues like

credit card fraud, or financial

and/or medical identity theft

Dental

Information

Line

For Cigna Dental

Care (DHMO) only

24/7 access to trained professionals

who can help answer your

questions about dental treatment

and clinical symptoms

.

** Cigna’s identity theft services are provided under a contract with General Global Assistance. Presented here are highlights of the identity theft

program. Full terms, conditions and exclusions are contained in applicable service agreement. This program is NOT insurance and does not

provide for reimbursement of financial losses.

* Healthy Rewards is a discount program and is separate from your dental benefits. If your plan includes coverage for any of the services offered

through Healthy Rewards, this program is in addition to, not instead of, your plan benefits. Some Healthy Rewards programs are not available in all

states and may be discontinued at any time. A discount program is NOT insurance, and you must pay the entire discounted charge.

PROGRAMS

& SERVICES


Cigna Healthy Rewards

Cigna

Healthy

Rewards®*For DPPO and

Cigna Dental Care

(DHMO)

.

* Healthy Rewards is a discount program and is separate from your dental benefits. If your plan includes coverage for any of the services offered

through Healthy Rewards, this program is in addition to, not instead of, your plan benefits. Some Healthy Rewards programs are not available in all

states and may be discontinued at any time. A discount program is NOT insurance, and you must pay the entire discounted charge.

PROGRAMS

& SERVICES


Identity Theft Resolution Services

Identity Theft

Resolution

Services*

For Cigna Dental

Care (DHMO) only

.

* Cigna’s identity theft services are provided under a contract with General Global Assistance. Presented here are highlights of the identity theft program. Full

terms, conditions and exclusions are contained in applicable service agreement. This program is NOT insurance and does not provide for reimbursement

of financial losses.

PROGRAMS

& SERVICES


If you suspect you might be a victim of identity theft, call

1.888.226.4567 (U.S. and Canada)or 202.331.7635.

Personal case manager care standing by to help you.

Please indicate that you are a member of the Cigna

identity theft program and group #57.

Valuable help before and after identity theft.

Our identity theft program provides tools and guidance to help with prevention,

detection and resolution.

› Education on how to identify and avoid identity theft before it happens

An identity theft protection kit that provides the right documents to use and

steps to follow if your identity has been compromised

› Help to complete an identity theft affidavit and cancel lost credit cards

› Guidance to help you replace credit cards, a driver’s license, Social Security

card, passport, etc.

› Assistance with understanding your credit reports to determine if identity theft

has occurred, and help with reporting an identity theft to credit reporting

agencies

› Help with emergencies while traveling, including translation services with

local authorities, filing a police report, and emergency message relay

› Up to $1,000 cash advance if your wallet or purse is stolen when traveling

more than 100 miles from home**

Dental Information Line. PROGRAMS

& SERVICES


Dental

Information

Line

For Cigna Dental

Care (DHMO) only

We’re there for you, when you need

it most

With your Cigna Dental Care plan,

you get personal support 24/7/365.

Dental Information Line. Trained

professionals can answer your

questions about dental care and

clinical symptoms.

1.855.511.6366


ENROLLMENT & PLAN INFORMATION

Enrollment in the DHMO is Easy


• Open Enrollment will run May 13 through June 7

• Each employee remains in the plans they are currently in

UNLESS THEY FILL OUT A FORM AND MAKE A NEW

ELECTION!

• Any employee wishing to enroll in the DHMO will need to fill

out our City enrollment form and “Check that DHMO Box”

it’s that simple!

• You also need to select a dentist when you enroll.

You will need to enter a dentist ID# on the enrollment form.

Call Cigna or go to www.cigna.com to obtain the ID# number.

http://www.cigna.com/

Look up a Cigna DHMO provider:


Call us at: 855.511.6366

Dentist ID#

Plan Information & Communication


• Detailed Plan Information will be made available:

• Via Open Enrollment Notice (postcard) to each Home

• On the City of Waterbury Website; Pension & Benefits

o www.waterburyct.org/benefits

• To Each Union President

• To Each Department Head

• Via P&B’s “Brass Benefits” e-blast

• Via interoffice mail

• If any group requests a presentation Cigna will be happy to

accommodate

• If needed, a Cigna Representative – Will set Office Hours at

City Hall

http://www.waterburyct.org/benefits


Q&AWhat you want to know

24

Dentists who participate in Cigna’s network are independent contractors solely responsible for the treatment provided and are not agents of Cigna. The information in this

presentation summarizes the highlights of your plan. For a complete list of both covered and not covered services, including benefits required by your state, see your

employer’s plan booklet, evidence of coverage, insurance certificate, or summary plan description – the official plan documents. If there are any differences between the

information in this presentation and the plan documents, the information in the plan documents takes precedence.

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. Cigna Dental Care (DHMO) plans are insured by Cigna

Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health

of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (KS & NE), Cigna

Dental Health of Kentucky, Inc. (KY & IL), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental

Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of

Virginia, Inc. In other states, Cigna Dental Care plans are insured by Cigna Health and Life Insurance Company (CHLIC), or Cigna HealthCare of Connecticut, Inc., and

administered by Cigna Dental Health, Inc. Dental PPO plans are insured or administered by CHLIC or Connecticut General Life Insurance Company, with network

management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Texas, the insured dental plan is known as Cigna Dental Choice, and this plan

uses the national Cigna DPPO network. Policy forms: OK – Dental Indemnity/PPO: HP-POL99 (CHLIC); DHMO: HP-POL115 (CHLIC); OR – Indemnity/DPPO/DEPO: HP-

POL68, DHMO: HP-POL121 04-10; TN – Dental Indemnity/PPO: HP-POL69/HC-CER2V1 et al. DHMO: HP-POL134/HC-CER17V1 et al. (CHLIC). The Cigna name, logo, and

other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures are used for illustrative purposes only.

862420 d 08/18 © 2018 Cigna. Some content provided under license.

Documents

VOLUNTARY DENTAL PLAN OPTION - DHMO · • DHMO network is a subset of the current Flex2 network that you use today. • You must go “In-network” to use the DHMO plan • Plan